Adolescent alcohol use is a significant public health problem among U.S. adolescents. Past studies, including our own work, have found that rural adolescents were more likely to use alcohol than urban adolescents. Research suggests that protective factors, such as peer and parental disapproval, may be weaker among youth living in rural areas. This study examines the factors associated with adolescent alcohol use, whether they differ between rural and urban populations, and the extent to which these differences account for rural-urban variations in adolescent alcohol use. This knowledge is crucial to the development of rural-specific prevention strategies, targeted research on rural adolescent alcohol use, and long-term policy interventions. Our findings confirm higher rates of binge drinking and driving under the influence among rural youth than among urban youth. Rural residence is associated with increased odds of binge drinking (OR 1.16, p< .05) and driving under the influence (OR 1.42, p< .001) even when income and protective factors are taken into account. Our findings suggest that adolescents who start drinking at an earlier age are more likely to engage in problem drinking behavior as they get older, leading to a need for interventions that target pre-teens and younger adolescents. Moreover, since we found urban-rural differences in specific protective factors, these may be the most promising for evidence-based, rural-specific prevention strategies targeting parents, schools, and churches. These are the factors that convey and reinforce consistent messages discouraging adolescent alcohol use from an early age.